This is a new submission to the Services Research Branch for funding of a randomized trial of rural-based Assertive Community Treatment (ACT). One hundred and twenty one subjects with severe and persistent mental illnesses (SPMI) meeting study eligibility criteria have been randomly assigned to RURAL ACT or usual services and allowed for changes in symptomatology, functioning, family burden, quality of life, and costs. The clinical intervention is well implemented and the research project has proceeded without interruption, however, due to initial delays in funding and initial difficulty recruiting clinical staff for rural-based work, additional time is required to complete the original study aims. In two and one-half years we have enrolled the patient cohort and almost completed the six month follow-ups. We are seeking support to complete the follow-up assessments on subjects enrolled in this study and to analyze the client, family and cost data. Continued extramural funding will achieve the following tasks: 1) complete 6-, 12- and 18-month interviews with clients, case managers and family members on 121 enrolled clients; 2) obtain cost data (health, mental health, jail/correctional/courts, family and maintenance (SSI, SSDI) for the 6-, 12-, and 18-month follow-up periods; 3) analyze the effects of the experimental intervention on client symptoms, functioning and quality of life at 6-, 12-, and 18-month periods; 4) analyze the effects of the experimental intervention of service utilization for each follow-up period; and 5) evaluate overall costs and effectiveness of ACT relative to the comparison condition (a community mental health center with case management). Specific hypotheses will be tested in the areas of mental health status, patient functioning, quality of life, health and mental health services use and costs. This study is significant from a number of perspectives: l) this clinical trial is being conducted in a rural setting; 2) the presence of special populations including a largely African American sample and significant mental illness-substance abuse co-morbidity; 3) evaluation of a mature program for an 18-month service period; 4) a complete assessment of costs: 5) the presence of an urban cohort from a parallel randomized clinical trial of ACT a neighboring urban area. This study is offered as a Public Academic Liaison (PAL) because of its integral and essential relationships with the State of South Carolina, the local community mental health program, and the Medical University of South Carolina. It is responsive to the Research on Mental Disorders in Rural Populations program announcement, the Effectiveness and Outcomes of Mental Health Services program announcement, and to the NIMH National Plan of Research to Improve Care for Severe Mental Disorders.